5.0 Attachment 05 - Example of a Certificate of Recycling.docx

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HAWAII HAZARDOUS WASTE REMOVAL & DISPOSAL
Solicitation number
SP450021RXXXX
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RFP No. SP4430-06-R-0001

SP4500-21-R-0009

Hawaii HW

ATTACHMENT 05

Example of a Certificate of Recycling

CERTIFICATE OF RECYCLING

Contract Number:

Company Name:

EPA I.D. Number:

Delivery Order Number:

Date:

This document is to certify that
(Company Name)
has completed the

recycling of your hazardous waste.

Under civil and criminal penalties of law for the making or submission of false or fraudulent statement or representations (18 U.S.C. 1001 and 15 U.S. C. 2615), I certify that the information contained in or accompanying this document is true, accurate, and complete.

I certify as the company official having supervisory responsibility for the persons who acting under my direct instruction made the verification that this information is true, accurate, and complete.

Company Officer’s Signature

Date

Title

Generator:

CLIN:

Manifest Number(s):

Weight:

Approved by:

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